Understanding Hyperandrogenism: A Guide to High Androgen Levels

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer

Hyperandrogenism is an excess of male sex hormones (androgens) such as testosterone in the body. It causes acne, oily skin, excess hair growth (hirsutism) and irregular periods. Polycystic ovary syndrome (PCOS) accounts for 80% to 90% of cases in females, and it mainly affects females of reproductive age. Treatments include hormonal birth control, anti-androgens and lifestyle management. [1]

What the research says

• Most women with PCOS turn out to be hyperandrogenic when steroid profiles are measured. In a cross-sectional study of 156 women with PCOS and 141 controls, 90% of the women with PCOS were hyperandrogenic once a full steroid profile was included in the definition, and hirsutism and high androgen levels could not be used interchangeably to define hyperandrogenism. (Pasquali et al., Journal of Clinical Endocrinology & Metabolism, 2016)

• Once a tumor is excluded, PCOS is the most common cause, and treatment differs by cause. A clinical review reports that hirsutism is the most common presenting symptom, that surgical resection is curative for tumor-related hyperandrogenism, and that medical management is the mainstay for non-tumor causes. (Sharma & Welt, Medical Clinics of North America, 2021)

• Birth control pills are the usual first-line drug treatment for hirsutism. The Endocrine Society guideline suggests combined estrogen-progestin contraceptives for most premenopausal women, adding an antiandrogen after 6 months if the response is suboptimal, and recommends against antiandrogen monotherapy unless adequate contraception is used. (Martin et al., Journal of Clinical Endocrinology & Metabolism, 2018)

What is hyperandrogenism?

Hyperandrogenism is a hormonal condition characterized by abnormally high levels of androgens in the body. Androgens are a group of sex hormones that play a critical role in starting puberty, reproductive health, and overall body development. While these hormones are often associated with males, they are produced by everyone in varying amounts. In males, androgens are primarily produced in the testicles, while in females, they are made in the ovaries. Both sexes also produce these hormones in the adrenal glands. [1]

The most well-known androgen is testosterone. When the balance of these hormones is disrupted, it can lead to various physical and metabolic changes. Hyperandrogenism affects approximately 5% to 10% of females of reproductive age and is significantly less common in males. While it is closely related to polycystic ovary syndrome (PCOS), the two are not identical; PCOS is just one of several potential causes for elevated androgen levels. [1]

What are the symptoms of hyperandrogenism?

The symptoms of hyperandrogenism are diverse and depend heavily on the individual's sex and whether they have reached puberty. In many cases, symptoms can manifest even if blood tests show androgen levels within a normal range. Conversely, some individuals may have high levels without noticeable physical signs.

Symptoms by demographic

Demographic	Common symptoms
Females (pre-puberty)	Enlarged clitoris, acne, oily skin, and coarse body hair (hirsutism).
Males (pre-puberty)	Enlarged penis, early pubic/armpit hair growth, and a deepening voice.
Adult females	Persistent acne, irregular periods, infertility, and male pattern baldness.
Adult males	Often no obvious symptoms, but can lead to infertility and testicle dysfunction.

It is important to note that if symptoms develop suddenly and rapidly, it may indicate a more serious underlying issue, such as an androgen-secreting tumor, and requires immediate medical attention. [1]

What causes hyperandrogenism?

Hyperandrogenism occurs when the organs responsible for producing or regulating androgens—such as the ovaries, testicles, or adrenal glands—fail to function correctly. The causes can range from common metabolic conditions to rare genetic disorders.

Primary causes

• Polycystic ovary syndrome (PCOS): This is the most frequent cause, accounting for the vast majority of cases in females. High levels of insulin and luteinizing hormone trigger the ovaries to overproduce androgens. [1]

• Congenital adrenal hyperplasia (CAH): A group of genetic conditions where the adrenal glands lack certain enzymes, causing them to produce excess testosterone instead of other necessary hormones.

• Cushing disease: A condition where the body produces too much cortisol, often due to a pituitary tumor. This excess hormonal activity also prompts the adrenal glands to release more androgens.

• Androgen-secreting tumors: Rare tumors in the ovaries, testicles, or adrenal glands can release large amounts of androgens into the bloodstream.

• Medications: Certain drugs, including anabolic steroids, synthetic progestins, and some antiseizure medications, can artificially elevate androgen levels. [1]

How is hyperandrogenism diagnosed, and what complications can occur?

Healthcare providers typically diagnose hyperandrogenism through a combination of physical examinations and specialized blood tests. During the exam, doctors look for signs like hirsutism or severe acne. They also review the patient's medical history, focusing on puberty onset and menstrual regularity.

Diagnostic blood tests

Test	Purpose
Total testosterone	Measures the overall amount of testosterone in the bloodstream.
Free testosterone	Measures the small percentage of testosterone not attached to proteins.
DHEAS	Screens for adrenal gland activity; high levels may suggest an adrenal tumor.
17-hydroxyprogesterone	Used to screen for non-classic congenital adrenal hyperplasia.

If left untreated, hyperandrogenism can lead to long-term health complications, including infertility, Type 2 diabetes, high blood pressure, and an increased risk of heart disease. [1]

How is hyperandrogenism managed and treated?

The primary goal of treating hyperandrogenism is to lower androgen levels or block their effects on the body. The specific approach depends on the underlying cause and the symptoms the patient wishes to address.

Common treatments

1. Medications: Birth control pills are often used to regulate periods and treat acne. Spironolactone can block the effects of androgens to reduce hair growth, while corticosteroids may be prescribed for adrenal-related causes. Because antiandrogens like spironolactone can harm a developing male fetus, they should be used with reliable birth control. [1]

2. Lifestyle changes: For those with PCOS-related hyperandrogenism, maintaining a healthy weight and regular exercise can improve insulin resistance and lower androgen production.

3. Surgery: In rare cases where a tumor is the cause, surgical removal of the growth is necessary to restore hormonal balance.

Conclusion

Hyperandrogenism is a complex hormonal disorder that requires careful diagnosis and a personalized treatment plan. Whether caused by PCOS, genetic factors, or medication, managing the condition effectively can prevent long-term complications and improve daily quality of life. If you suspect you have symptoms of high androgen levels, consulting an endocrinologist or reproductive specialist is the first step toward recovery.

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Frequently Asked Questions

Is hyperandrogenism the same as PCOS?

No. While PCOS is the most common cause of hyperandrogenism in females, hyperandrogenism simply refers to the state of having high androgens, which can be caused by many other conditions.

Can men have hyperandrogenism?

Yes, though it is less common. In men, it is often caused by adrenal issues or external sources like anabolic steroids.

Does hyperandrogenism cause weight gain?

Hyperandrogenism is often associated with obesity and insulin resistance, which can lead to weight gain, particularly in cases linked to PCOS.

Can I get pregnant if I have hyperandrogenism?

High androgen levels can cause infertility by disrupting ovulation, but many people are able to conceive with appropriate medical treatment.

Will the excess hair growth go away with treatment?

Treatments like spironolactone and birth control can slow new hair growth, but existing hair may require cosmetic treatments like laser removal.

Is hyperandrogenism dangerous?

If left untreated, it increases the risk of metabolic issues like diabetes and heart disease, but it is generally manageable with medical care.

Can stress cause high androgen levels?

Stress can affect the adrenal glands and overall hormonal balance, potentially exacerbating symptoms in some individuals.

What is hirsutism?

Hirsutism is the growth of coarse, dark hair in areas where it is typically found in males, such as the face, chest, and back.

Are there natural ways to lower androgens?

Weight management and exercise are effective natural strategies for improving insulin sensitivity, which in turn helps lower androgen production.

How long does it take for treatment to work?

It often takes several months (3-6 months) to see significant changes in symptoms like acne or hair growth after starting medication.

Can children have hyperandrogenism?

Yes, it can cause early puberty symptoms in both boys and girls.

What is DHEAS?

DHEAS is a hormone produced primarily by the adrenal glands. Measuring it helps doctors determine if the excess androgens are coming from the adrenals.

Does hyperandrogenism cause hair loss?

Yes, it can cause "male pattern baldness" or thinning of the hair on the scalp in females.

Is hyperandrogenism genetic?

Some causes, like congenital adrenal hyperplasia, are directly genetic. PCOS also tends to run in families.

Should I see an endocrinologist?

Yes, endocrinologists specialize in hormone disorders and are the best qualified to manage hyperandrogenism.

Related Reading

• Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, Diagnosis, and Treatment

References

1. Cleveland Clinic. Hyperandrogenism: What It Is, Symptoms & Treatment. Cleveland Clinic. Medically reviewed; last updated August 11, 2025. https://my.clevelandclinic.org/health/diseases/24639-hyperandrogenism

2. Pasquali R, Zanotti L, Fanelli F, et al. Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: A Challenging Perspective. J Clin Endocrinol Metab. 2016;101(5):2013-22. PMID 26964728. https://doi.org/10.1210/jc.2015-4009

3. Sharma A, Welt CK. Practical Approach to Hyperandrogenism in Women. Med Clin North Am. 2021;105(6):1099-1116. PMID 34688417. https://doi.org/10.1016/j.mcna.2021.06.008

4. Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233-1257. PMID 29522147. https://doi.org/10.1210/jc.2018-00241

Medical disclaimer

The information provided in this article is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of hormonal disorders.